Equitable health claim form

To ensure you maximize your benefit coverage, review any coverage you have through any provincial health insurance or private plan and claim accordingly. Sign In; Click Submit EZClaim; Fill out the interactive form; Attach your receipt; SUBMIT. To make an extended health care dental claim and/or disability claim , you may print, complete and submit the appropriate form to Equitable Life. Any medical information provided on or through this Site, either by Equitable Life or. You acknowledge and agree that any claim or cause of action you may have.

Certain secure areas of the Site may contain electronic forms or documents . SENDING THE ENROLMENT FORM TO EQUITABLE LIFE. EXTENDED HEALTH BENEFITS CLAIMS. Email group- health - claims @ equitable.

PlEasE ComPlETE anD siGn rEvErsE siDE. The claim information willingly provided by me to Equitable Life held in their files,. SUPPLEMENTARY MEDICAL BENEFITS. The EQUITABLE LIFE insurance company.

One Westmount Road North PO Box . Equitable EZClaimTM (Mobile or Online), by email, fax or regular mail. I authorize Equitable Life to deposit Group Claim payments directly into my bank. Form 4- Application for Coverage of Dependent Child Over Age 2 along . Health or Dental claim form. Let us to help you with a no medical life insurance quote , meaning that you do not.

I should try to send in a claim form for whatever I did in the past. You can to myAXA and view the progress of your claim anytime. We welcome you as a member of this Equitable Life Group Benefits Plan. Please “paper” claim this expense using Form 4– Supplementary Medical.

When you go to your Dentist, take a Form #5- Dental Claim Form with you or get one. The purpose of this form is to enable us to process your claim as quickly as possible and to assist us in evaluating the possibility of. Confined in a hospital bed or other medical institution.